Monday, February 1, 2016

Athlete Heart Advice for Coaches

by Larry Creswell, M.D.

I get a bunch of inquiries from athletes about various heart issues. Surprisingly, though, I get relatively few inquiries from coaches. But when I do hear from coaches, they generally ask one of two questions:

  1. Can I get my athlete to talk with you about a potential heart issue?
  2. What do I need to know about…?

Both are great questions. The first question is easy. I’m generally happy to talk with athletes about heart issues and help point them in the right direction to find help.

Today, let’s deal with the second question.

In school-based athletic programs and many elite or professional programs or teams, there’s a medical staff that’s charged with athletes’ medical well-being. The coach is then part of a team that includes the medical professionals. As a result, there’s always an “in house” source of medical information to help guide the coach.

The situation is different, though, for most coaching arrangements in adult recreational sports like triathlon. Here, we generally have a stand-alone coach or coaching staff that doesn’t have the benefit of in house medical expertise.

I thought I’d share some thoughts and suggestions for coaches in this latter situation. I’ll focus on heart problems here, but the approach should be no different for other medical conditions and specialists.

I see things as a team, with an athlete “captain” and various team members, including a coach and doctor(s). The responsibility for managing the team necessarily falls to the athlete. Coaches can’t be the doctor, but they should be aware of their athletes’ major medical issues. Doctors can’t be the coach, but they should be aware of the athlete’s plans for exercise, training, or competition. The team works best when there’s ample communication.

On-Site Coaching
The important consideration here is safety planning. Coaches might go an entire career and never have to deal with a medical emergency, but it’s best to be prepared.

  • Get certified in CPR and the use of the automatic external defibrillator (AED) and maintain your certification. Encourage your athletes to do the same. We’re safest when we’re surrounded by trained bystanders.

  • Know where to find an AED at the swimming pool, fitness center, or other locations where you coach. Make sure that new athletes to your group know, too.

  • Understand how the local EMS system works. Is there cell phone coverage at training locations? Where is the nearest hospital or emergency room?

  • Be aware of skill sets among your athletes. Let the group know who’s a nurse, doctor, EMT, or paramedic.

Athletes without Heart Problems

By far, coaches are primarily coaching athletes who don’t have known heart problems Coaches can help these athletes in a variety of ways:

  • Screening and prevention of heart disease is important. Encourage your athletes to establish and maintain a relationship with a medical provider. Remind them that it’s the athlete’s responsibility to show up healthy for whatever training is planned. Ask you athletes to let you know about major medical problems.

  • Know the important warning signs of heart problems: chest pain or discomfort, particularly with exertion; unexplained shortness of breath; unusual fatigue; light-headedness or loss of consciousness, particularly while exercising; and palpitations. Teach your athletes to be vigilant for these warning signs. Listen carefully to your athletes if they describe these problems during training.

  • Be a nudge. Middle-aged male athletes, in particular, are often reluctant to go to the doctor. But they might very well share their story about one of the important warning signs with their coach. Make sure your athlete gets checked out if there is any concern about a possible heart problem.

  • Sometimes an unexpected decline in physical performance is the first clue to a serious medical problem. The coach might well be the first to take notice. As you work through the possibilities, don’t forget to engage the help of the athlete’s doctor if something remains unexplained.

Athletes with Symptoms Undergoing Evaluation
Many endurance sport coaches will eventually encounter athletes who develop warning signs or symptoms for heart disease and need medical evaluation. There are too many potential scenarios to review here and moreover, it’s not the coach’s job to be the doctor. The safest course of action is to suspend training until an athlete’s problem gets fully evaluated. Be firm about this. Athletes are often inclined to continue training, but this isn’t wise.

Athletes with Heart Problems
This is obviously the most complicated situation. Again, there are just too many different heart conditions to consider each one here. But heart problems usually fall into one of two categories: those that can be cured or those that can only be managed.

  • Cures - Some athletes have heart conditions that are essentially “cured” with treatment. One example would be an athlete with supraventricular tachycardia (SVT), an arrhythmia originating in the upper chambers of the heart. This condition can be cured with an ablation procedure and the athlete can return to sport without restriction.

  • Managed problems - Most heart conditions are not cured, though. They’re simply managed. That management might be as simple as a prescription medication for high blood pressure or as complicated as a heart transplant for end-stage heart failure. In this category, I’d also include those athletes with heart problems that have been recognized in early stages and that don’t yet require treatment. Examples might include bicuspid aortic valve or infrequent atrial arrhythmias. In all of these situations, the athlete is left with a condition that requires ongoing monitoring. Coaches should know that the form, type, duration, and intensity of exercise may be limited somehow by the condition or may make the condition worse, in the near or long term.

  • Engage the doctor(s) - For any athlete with a treated heart condition, it’s prudent to get advice about exercise, training, and competition directly from the doctor(s). This is true not only for the return to training after a newly-treated condition, but also for the long term. Don’t make assumptions about the doctor’s awareness of the athlete’s training routine. You can help facilitate the needed discussion between athlete and doctor by writing down, in detail, the scope of your planned training (such as type of sport, duration, intensity, frequency, volume and weight training). Ask your athlete to use that piece of paper to guide a detailed discussion with the doctor and to develop a prescription about any limitations that are needed for safety’s sake. Review that prescription with your athlete as you make.

Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains The Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at
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